Providers addressing lack of child psychiatrists

June 23--BLOOMINGTON -- Mental health professionals and pediatricians agree: There's a shortage of child psychiatrists, especially those who treat children on Medicaid.

Possible solutions are where things get complicated.

But two recent developments are helping. One is improved reliability and increasing prevalence of teleconferencing between local primary care providers and child psychiatrists, a collaboration that makes it easier for children to get diagnosed, treated and prescribed appropriate medication.

The second development is Dr. Diana Chu's decision to accept a full-time child psychiatrist position with Chestnut Health Systems'Family Health Clinic.

"I would say, right now, we're in a better place than we've been in six to seven years," said Dr. Rob Lusk, director of clinical services for The Baby Fold.

But everyone agrees OSF Resource Link that provides teleconferencing, and Chu are only the start of a long journey to improve services for the growing number of children with mental illness.

"This is a massively growing problem everywhere," said Dr. Aaron Traeger of Advocate Medical Group Pediatrics-Bloomington.

As many as 20 percent of children may have a mental illness, added Dr. David Milligan of OSF Medical Group-Pediatrics, Bloomington.

Many pediatricians are comfortable treating attention deficit hyperactivity disorder and mild depression or anxiety, said Traeger and Milligan. But when symptoms are more severe -- like when a child has bipolar disorder, becomes suicidal or has a behavioral disorder -- pediatricians prefer to refer to psychiatrists.

But there is a nationwide shortage of child psychiatrists.

Additional training to become a child psychiatrist means a psychiatrist can't open a practice until about age 32. By that point, he or she can be about $200,000 in debt and child psychiatry is among the lower-paying medical sub-specialties.

Child psychiatry also is complex and patients don't get well immediately.

Also, few psychiatrists see Medicaid patients, not only because the doctors are overwhelmed and reimbursement is low, but because, with children exposed to trauma or in foster care, there may be court proceedings, said Lisa Pieper, regional vice president for Children's Home & Aid.

"That adds a complicating factor to something that already is not attractive to a lot of providers," Pieper said.

Children on Medicaid who are 12 years and older may be served by the Center for Human Services, but the wait list is long, noted Kelly Barnes, OSF Resource Link care coordinator.

For children under 12 with private insurance, there are three child psychiatrists in Bloomington-Normal.

For young children on Medicaid, the options are Chu and another child psychiatrist who is seeing a limited number of Medicaid patients, but doesn't want his name used because he's concerned about becoming inundated.

A couple other child psychiatrists come to McLean County one day a week, Barnes said, while the Center for Youth and Family Solutions provides emergency crisis services. But children not in crisis frequently need to travel to other cities to see psychiatrists.

Navigating the system

That's why OSF Healthcare System started Resource Link. "My job is to help families navigate the system," Barnes said.

Families are referred to Barnes by pediatricians and family practice doctors. She meets with families and helps to schedule appointments with psychiatrists and counselors and follows up with families.

Barnes also coordinates teleconferences between primary care doctors and two psychiatrists (one from Peoria, the other from the Chicago area) so they can collaborate on diagnoses, treatments and medications.

"About 80 percent of my clientele is on Medicaid and the rest is private insurance," she said.

Since Resource Link expanded to McLean and Livingston counties three years ago (Barnes also serves families in six other counties), the program has grown. In the fiscal year that ended Sept. 30, 232 children in the two counties were served; 139 have been served so far this fiscal year. Sixteen medical practices in the two counties have referred children to the program.

"For parents who follow through, most of the children get better," she said.

"I don't call this a solution," Barnes said. "But it provides assistance to help fill the gap. A solution would be more child psychiatrists."

Another telephone consultation service used locally is Illinois DocAssist that connects primary care physicians with child and adolescent psychiatrists and other behavioral health clinicians, said Maureen Sollars of the McLean County Health Department's All Our Kids Early Childhood Network.

The first step to getting more people interested in psychiatry is for society to change its attitude about mental illness, physicians said.

"These are not personality weaknesses or shameful problems, but real diseases that occur," said Dr. Paul Pedersen, vice president and chief medical officer of OSF St. Joseph Medical Center.

"You wouldn't tell someone with diabetes, 'Stop doing it,' " Traeger said. "So why do we say that to people who can't control their behavior? People need to view mental health like they view physical health: as conditions that need to be treated."